Relative Risk of Brain Tissue Loss From Relapse/Antipsychotics


Nancy Andreasen and colleagues explore progressive brain tissue loss associated with a diagnosis of schizophrenia in an article appearing this month in the American Journal of Psychiatry. Data drawn from 202 patients suggest that duration of relapse is associated with brain tissue loss in the frontal lobes, while antipsychotic treatment effects were diffusely distributed. The authors suggest that treatment is indicated to prevent relapse, but with care to use the lowest possible dosages.

Article →

Andreason, N., Liu, D., Ziebell, S., Vora, A., Beng-Choon, H; Article
Relapse Duration, Treatment Intensity, and Brain Tissue Loss in Schizophrenia: A Prospective Longitudinal MRI Study. American Journal of Psychiatry 170:609-615; June, 2013

Of Further Interest:
The Long-Term Effect of Schizophrenia on the Brain: Dementia Praecox? (American Journal of Psychiatry, Editorial)

Previous articleOutpatient Treatment Reduces Risk of Arrest
Next articleIndustry Influences Distort Healthcare Research, Strategy, Expenditure and Practice
Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. Due to brain fog, I didn’t read the article very carefully. But I am sensing that Nancy Andreason is going back on her previous acknowledgement that the meds are causing the loss of brain tissue and not schizophrenia. Please correct me if I am wrong.



    Report comment

  2. Let me get this straight…

    Dr. Nancy Andreasen first says that neuroleptics cause brain shrinkage, but now insists that staying on a small amount as a maintenance dose prevents brain relapse, brain shrinkage?

    And so what is someone supposed to do with that information?
    Other than assume the person who said it is not very rational.


    Report comment

    • There is nothing irrational about it. She claims both “anti-psychotics” and “relapse of schizophrenia” cause loss of brain tissue. But if you read the article on MIA this issue by Dr Moncrieff you’ll see that that the data does not show what Andreasen et al claim.

      The “relapse” is not independent of the ingestion of drugs.In fact this group uses the term “relapse” but they are really describing a worsening of symptoms correlated with dosage of drugs. In order to put the blame on relapse independent of drugs you’d have to have a population of “schizophrenics” who were not on neuroleptics. And that does not exist. What the data shows is that brain changes are related to–probably caused by–the use of neuroleptics.

      AS Moncrieff states,”These researchers seem determined to prove that ‘schizophrenia’ causes brain shrinkage, although their data simply cannot establish this, as none of their subjects seem to have gone without drug treatment for any significant length of time. So even though their recent analysis once again confirms the damaging effects of antipsychotics, they conclude that the results demonstrate the need to make sure patients take, and do not stop, their antipsychotic medication. The only concession made to the antipsychotic-induced changes revealed is the suggestion that low doses of antipsychotics should be used where possible.”

      But Andreasen insists the problem is the relapse. She implies the drugs are neuro-protective. Why? This is part of the new propaganda. Take a look at Bob’s article in this issue of MIA on his talk at the Vatican. He describes the new propaganda,”Whereas psychiatry once told of psychiatric drugs that fixed chemical imbalances, the field is now telling of how the drugs may be “neuroprotective,” protecting against some toxic disease process; or how they may stir the growth of new neurons in select areas of the brain, which is seen as helpful; or that, in the case of stimulants, they somehow counter abnormal brain development said to be common to youth with ADHD. All of these tell of how the drugs, in some manner or another, are good for the brain.”

      Andreasen’ story is similar. Schizophrenia she claims is a brain-damaging drug. If left to itself patients will relapse. The drugs protect the brain–although they have to be used at lower doses than in the past. But “relapses” are so harmful that patients must be forced to take “anti-psychotics.” This is the propaganda you will be hearing over and over. It’s a lie, but a new lie and it SOUNDS credible.
      Seth Farber, Ph.D.

      Report comment

      • But of course, we have many studies, many of them verging on being old now, that prove the lie to all of this. Courtney Harding’s studies, the WHO studies, Dr. Martin Harrow’s fifteen and twenty year studies. How do they explain that prior to the arrival of the drugs (thorazine, haldol) the percentage of people recovering from psychosis and the Big S was almost 66%. What’s today’s recovery rate? Something like 16%? How do they get away with the outright telling of lies in the face of the facts gained from real, scientific studies? I guess the larger and more important question is why does our society listen to and believe them in the first place?

        Report comment

        • The whole belief system in regard to the brain blaming cult is facile, and this debate about beliefs that get labeled ‘delusional’ as being beliefs that shrink the brain, is infantile.

          The people who believe this, are essentially saying that believing you are Jesus Christ, or believing that the CIA is out to get you, literally shrinks your brain. Literally damages your brain, to believe things the majority labels false beliefs.

          People who make claims that one particular thought is literally toxic to the brain, are not serious thinkers.

          Report comment

  3. Parts of this paper suggesting politics of control make me sad.

    “Schizophrenia is one of the most important brain diseases that psychiatrists treat.

    Adherence can be maximized in a variety of ways: maintaining good rapport and frequent supportive con- tact, choice of medications that have the lowest aversive side effects (such as akathisia and extrapyramidal side effects), and use of long-acting injectable medications.

    Teasing apart the mechanisms by which relapse may lead to brain tissue loss will require rigorous clinical trials, preferably with random assignment of medications that enhance treatment adherence (e.g., long-acting injectable agents versus treatment as usual) …”

    Report comment

    • I think that maybe with their injection comments they are driving an approval for a new study or studies where they will be giving injections of neuroleptics to the patients so that they can measure the brains of the studies over years. I kid you not. It is sick that they seek out methods to make people more “adherent” to their power. It is even more sick that they call injections one method of “adherence”.

      Report comment

  4. I don’t need Dr Andreasen’s linguistic equivocations to know what I need to know about Dr Andreasen. I looked her up as Principle Investigator in the NIH databases some years ago.

    In 1992 the NIH handed her 4 Awards $1,998,219.00
    In 1993 the NIH handed her 5 Awards $2,518,408.00
    In 1994 the NIH handed her 5 Awards $2,737,473.00
    In 1995 the NIH handed her 5 Awards $2,913,534.00
    In 1996 the NIH handed her 5 Awards $3,118,021.00
    In 1997 the NIH handed her 5 Awards $3,202,780.00
    In 1998 the NIH handed her 4 Awards $2,282,706.00
    In 1999 the NIH handed her 6 Awards $2,412,744.00
    In 2000 the NIH handed her 6 Awards $2,888,069.00
    In 2001 the NIH handed her 5 Awards $2,997,578.00
    In 2002 the NIH handed her 4 Awards $2,310,037.00
    In 2003 the NIH handed her 4 Awards $2,066,857.00
    In 2004 the NIH handed her 3 Awards $1,480,891.00
    In 2005 the NIH handed her 4 Awards $1,912,926.00
    In 2006 the NIH handed her 4 Awards $1,481,088.00
    In 2007 the NIH handed her 3 Awards $1,709,162.00

    Total: $38,030,493.00

    Now on to the NYT from 2008


    A. I haven’t published this yet. But I have spoken about it in public lectures. The big finding is that people with schizophrenia are losing brain tissue at a more rapid rate than healthy people of comparable age. Some are losing as much as 1 percent per year. That’s an awful lot over an 18-year period. And then we’re trying to figure out why. Another thing we’ve discovered is that the more drugs you’ve been given, the more brain tissue you lose.


    A. Well, what exactly do these drugs do? They block basal ganglia activity. The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy.

    If I were developing new drugs, I’d switch targets. Till now it’s been chemically formulated targets. I believe we should be thinking more anatomically and asking, “With schizophrenics, which brain regions are functioning abnormally?”


    A. The reason I sat on these findings for a couple of years was that I just wanted to be absolutely sure it was true. My biggest fear is that people who need the drugs will stop taking them.



    Over $38 Million dollars of other people’s money, and she sits on her findings for a couple of years.

    Sitting on those $38 Million Dollar Findings was not her decision to make.

    Those $38 Million Dollars belong to the American people, NOT HER.

    Report comment

        • Duane;

          $38 Million, for photographic Proof of these drugs eating brains and she “Sits on it for a couple of years?”

          The pics Should have been made available for peer review if she really gave a fig as to whether or not people needed to remain on them.

          And BTW, though my original links aren’t good at this point, in 2008 she was also sitting on AZ panels deciding which promising Young Investigator got a $45K Career Booster from AZ’s till.

          It’s no wonder she Sat on her research.

          Report comment

  5. Sounds like she’s attempting to salvage the old dogma that “you need to stay on your meds,” even though they’re shrinking your brain. Naturally, she avoids any reference to non-toxic, non-drug ways to avoid “relapse,” which would provide the desired protection without any long-term brain damage. Someone should send her some of the stuff from Open Dialog…

    — Steve

    Report comment

  6. This is a mortifying backpedal. Why did she even reveal her findings – so she could cash in on making them go away and touting injectables? What about all the patients given neuroleptics who are nowhere near experiencing “schizophrenia” or “psychosis,” the elderly, foster children, the mentally disabled, insomniacs? No comment from Andreasen.

    Report comment

  7. Found this on my screen capture of:
    which just returns me a 404 today.

    October 4, 2002

    No Sign Yet Of That Smoking Gun – Book Reviews By: Daniel Nettle

    Note: Links below take you to the link for purchasing the book. The Amazon link also has 25 pages of sample reading from Nancy Andreasen’s book for your review.

    Brave New Brain: Conquering Mental Illness in the Era of the Genome By Nancy C. Andreasen Oxford University Press 368pp, Pounds 24.99 ISBN 0 19 514509 7

    Which can be yours for 99 cents used.

    In Search of Madness: Schizophrenia and Neuroscience By R. Walter Heinrichs Oxford University Press 347pp, Pounds 32.50 ISBN 0 19 512219 4

    Hardly a week goes by without our reading of a particular psychological disorder that has been traced to a rogue brain chemical, or brain area, or beyond that to a genetic variant. These two books, in their different ways, reflect the fact that psychiatric research today sits at the intersection of neuroscience and genetics, and a very long way from the psychodynamic terrain it once occupied. Nancy Andreasen is one of the ushers of this ongoing paradigm shift. Twenty years ago, one of her books, The Broken Brain, became the general reader’s herald that the scientific consensus about psychological disorders was shifting. Here she returns to survey the ground, choosing this time the new genetics and brain scanning as the tools that are making light the dark recesses of the mind. Andreasen’s book is a solid enough overview of some aspects of modern biological psychiatry. Her summaries of the techniques of contemporary human genetics, and of brain scanning and the cerebral architecture it reveals, are extremely clear and useful. By the time she comes to survey the main psychological disorders, though, she has run out of steam slightly. Thus, while these chapters constitute useful introductions to schizophrenia, affective disorders, anxiety and dementia for those who have no prior knowledge, there is little in the way of synthesis of what we now understand to be the nature of these disorders or of the puzzles that remain.

    In the case of schizophrenia, for example, far from the twin searchlights of genetics and brain-scanning locating a nice clean smoking gun, they have revealed much more complexity and variability than we could possibly have imagined. Despite some welcome words about the need to avoid obstructive dichotomies (nature vs nurture, brain vs mind), Andreasen is not prepared to engage with the possibility that neurobiological research might make us question the whole conceptual framework – a set of neat, discontinuous disease categories – that her book employs. Anxiety and mood disorders, for example, are treated as separate chapters in the book without comment, while genetic and neurobiological evidence leads us increasingly to think of them as related or even different aspects of the same thing. Many of the brain abnormalities (and some of the genetic loci) associated with schizophrenia are also associated with bipolar mood disorders, a crossover difficult to accommodate within a discrete framework.

    So, . . . .

    Braaaaaain Psy-ence.

    And This next Bio-pantload was on the same NAMI page.

    December 11, 2002
    Brain Imaging May Detect Schizophrenia in Early Stages
    By ERICA GOODE, New York Times

    Scientists have known for some time that people who suffer from schizophrenia show abnormalities in the structure of their brains.

    But in a new study, researchers for the first time have detected similar abnormalities in brain scans of people who were considered at high risk for schizophrenia or other psychotic illnesses but who did not yet have full-blown symptoms. Those abnormalities, the study found, became even more marked once the illness was diagnosed.

    The subjects in the study who went on to develop psychoses had less gray matter in brain areas involved in attention and higher mental processes like planning, emotion and memory, the researchers found.

    Experts said the study’s results, reported yesterday in an online version of The Lancet, the medical journal, offered the possibility that imaging techniques might eventually be used to predict who will develop schizophrenia, a devastating illness that affects more than 2.8 million Americans. Doctors could then offer treatment while the disease was still in its earliest stages, possibly preventing further damage to the brain.

    But Dr. Christos Pantelis, an associate professor of psychiatry at the University of Melbourne and the lead author of the report, cautioned that much more research was needed before magnetic resonance imaging, the method used in the study, could serve as a diagnostic tool for individual people with schizophrenia.

    “I think it’s still too early to say how helpful it will be,” Dr. Pantelis said.

    Still, other researchers called the study’s findings exciting and said that the areas of the brain in which the abnormalities were found would now be an active focus for study.

    “This is a terrific first step,” said Dr. Paul Thompson, a professor of neurology at the University of California at Los Angeles and an expert on brain imaging and schizophrenia.

    Dr. Herbert Y. Meltzer, a professor of psychiatry at Vanderbilt University and an expert on schizophrenia, said, “It proves that the psychosis is almost a late stage in the evolution of the disease process.”

    He added, “The key message is that this is a neurodevelopmental disorder and that changes in memory, learning, attention and executive decision-making precede the experience of the psychosis.”

    People who suffer from schizophrenia typically experience auditory hallucinations and have blunted emotional responses and difficulty with activities that require planning or other higher-level processes.

    Some studies have suggested that the earlier the illness is treated with antipsychotic drugs the better the prognosis. At least two research groups, one led by Dr. Patrick McGorry, an author of the Lancet report, and another at Yale, are conducting studies in which young people who are experiencing some symptoms but have not yet developed schizophrenia are treated with antipsychotic drugs. But the studies have been controversial because it is not yet clear which symptoms predict later illness.

    In the new study, the researchers used magnetic resonance imaging to scan the brains of 75 people who were deemed “at high risk” for psychosis because they had a strong family history of severe mental illness or had other risk factors, including transient or mild symptoms of mental disturbance or a decline in mental functioning.

    Over the next 12 months, 23 of the subjects developed a full-blown psychosis and 52 did not fall ill, the researchers found.

    A comparison of the brain scans from the two groups revealed significant differences in the volume of gray matter in areas of the frontal and temporal lobes and the cingulate gyrus. All three regions have been linked to schizophrenia by previous research, Dr. Pantelis said.

    When the researchers conducted additional brain scans on some subjects who developed psychoses, they found further reductions in gray matter not seen in the scans taken before the illnesses were diagnosed.

    Uh-huh. A preventative poisoning with antipsychotics will prevent further brain shrinkage and perhaps stave off schizophrenia.

    Well, they say you can tell a bit about a person by the company they keep.


    Schizophrenia and Other Psychotic Disorders Work Group
    Nancy Coover Andreasen, M.D., Ph.D. Chairperson
    John M. Kane, M.D. Vice-Chairperson
    Samuel Keith, M.D.
    Kenneth S. Kendler, M.D.
    Thomas McGlashan, M.D.
    Schizophrenia Text Revision
    Michael Flaum, M.D. Co-Chairperson
    Xavier Amador, Ph.D. Co-Chairperson

    And that would be This Dr. Flaum who penned a piece asking Why all the fuss over the 1939 Monster Study where 22 orphans were experimented on to attempt to teach them to stutter, since no harm was intended and none done, according to Dr. Flaum.

    Report comment